On the trail of cancer: personalized cancer vaccine
On the trail of cancer: personalized cancer vaccine
Interview with Prof. Markus Lerch, Center for Internal Medicine at Greifswald University Hospital (Universitätsmedizin Greifswald)
Conventional cancer treatment selection typically depends on the location of the tumor. However, this approach ignores the distinct gene mutations in the tumor of the individual patient. New cancer research approaches increasingly emphasize the concept of personalized therapy. As part of a joint research project, scientists now study a new approach to cancer immunotherapy, which gives emphasis to an individualized treatment.
Prof. Markus Lerch
In this interview with MEDICA-tradefair.com, Prof. Markus Lerch talks about the goals of the new joint research project in Teterow, explains the specific approach used to develop cancer immunotherapies and reveals the potential of individualized cancer treatments.
Professor Lerch, what is the goal of this joint research project?
Prof. Markus Lerch: The Greifswald University Hospital, the University Hospital of Rostock, and the two biotechnology companies of Miltenyi Biotec GmbH and Centogene in Rostock are collaborating in our joint research project. The project aims to develop a new cancer immunotherapy treatment. We selected two tumor entities – colorectal cancer and pancreatic cancer since we have a high level of expertise in these areas. What’s more, there are currently no adequate treatment options for these two most common types of cancer.
What approach do you adopt in your immunotherapy research?
Lerch: We base the development of an adequate treatment on the known observation that genetic material mutates in tumor cells. As a result, unlike healthy cells, these tumor cells express other proteins on their surface. We want to use these altered surface properties to vaccinate the body’s own immune cells against these tumor cells. To do this, we extract immune cells – and in this case dendritic cells – from the patient. They are vaccinated with the patient’s own surface markers in a test tube. The vaccinated dendritic cells are subsequently re-administered to the patient. Once inside the body, they prompt the killer cells, T-cells, and other immune cells to first detect the tumor and then attack it. The Miltenyi Biotec GmbH is already conducting clinical trials for melanoma and skin cancer. The project is funded for six years. In the first step, individual tumor samples will be tested for their respective mutation. This type of therapy is very personalized. Tumor and immune cells have to be accurately characterized for each individual patient to subsequently produce the personalized vaccine.
What are your current challenges?
Lerch: Logistical factors that have not been worked out yet also play a role for example. We still need to determine how many cells have to be isolated to this end, how well they can be transported or how we ultimately have to vaccinate and multiply them. We need patient material that goes through a manufacturing process and can later be re-administered to the patient in the form of a drug. Many aspects have to be sorted out along the way, ultimately allowing us to check whether the patient actually develops enough of his/her own defense cells against the specific tumor that can then attack the cancer cells.
Our immunotherapy should also be administered in conjunction with conventional therapies. Conventional chemotherapy can cause immune cells to die. That’s why we also have to determine on an individual basis at what point during normal chemotherapy the patient’s own immune cells should best be transferred to cause the least amount of damage. These are all steps that we will sort out over the next six years.
Visiting the project partner Miltenyi Biotec (left to right): Prof. Christian Junghanß (university speaker of the project, University Hospital of Rostock), Stefan Miltenyi and Employee Julia Batzke (Miltenyi Biotec) and Harry Glawe (Economy Minister of Mecklenburg-Hither Pomerania).
What potential do you generally see in personalized cancer research approaches?
Lerch: These approaches hold great promise but there is also much hype. Many promises have not been fulfilled yet. There are still no personalized approaches pertaining to many tumor types. Having said that, several already existing personalized medicine approaches are getting more detailed with each passing year, especially when it comes to colorectal cancer. A few short years ago, we treated all patients with colorectal cancer in the same way. Today, we tailor the colon cancer treatment to the mutations in the tumor. Parameters like the exact tumor position on the left or right side of the colon or certain hereditary characteristics also play a major role. We are making continuous progress toward personalized medicine, which in turn increases the specialization of medicine. Personalized medicine has already reached a certain level when it comes to the treatment of skin cancer for instance. The different types of leukemia are also considered in a more differentiated manner. In the past, the assumption was that there is only one type of acute leukemia. Thanks to personalized medicine, we now know that there are actually six different types of leukemia. These have to be treated in different ways based on this observation.
In the case of colon cancer, we are also able to make increasingly accurate, more precise decisions for the individual patient. The grid is still pretty course but we expect to learn a lot from this study in terms of reaping a cancer treatment that truly considers the individual patient. At the moment, the individualization still tends to relate to patient groups. However, if this step works, patients can no longer be compared to each other when it comes to therapy. Cancer treatment could then be customized to the exact tumor characteristics and immune cells of the individual patient.
How does individualization actually impact the way studies are being conducted?
Lerch: It will become more difficult to conduct studies in the future. After all, the groups whose treatment is based on certain characteristics are shrinking. This changes the overall clinical trial strategy. In the past, treatment was based on the type of cancer or the affected organ. Today it is based on the tumor characteristics. The individualized approach is implemented via genetics or other specific tumor characteristics and is no longer tied to the tumor location. This makes things more complicated because in theory, you now need specialists in all clinical trials, who not only intimately know the respective type of cancer but who are also familiar with personalized treatment to combine and have the necessary expertise. These types of clinical trials are called basket studies. Multiple aspects are combined, which are all linked to the specific characteristics of the tumor or the patient but are no longer correlated with specific disciplines or tumor location.
The interview was conducted by Julia Unverzagt and translated from German by Elena O'Meara. MEDICA-tradefair.com